Caius Solovan

Mucosal melanomas in the elderly: challenging cases and review of the literature

Melanomas are malignant tumors that originate from melanocytes. They are most frequently localized in the skin, but 5% of all melanomas interest also extracutaneous sites as mucosal surfaces, parenchymatous organs, the retroperitoneum area, and the ocular ball. The purpose of this study was to investigate the epidemiologic and morphologic data of mucosal melanomas diagnosed at Emergency City Hospital (Timisoara, Romania) during a period of 12 years. The study included 17 cases of extracutaneous, extraocular melanomas, with 16 primary melanomas and one secondary melanoma. All our patients were older than 53 years and were mostly men. Most of the patients presented with localized disease; only one case had regional lymph node metastases, and another one had systemic metastases at the time of diagnosis. Regarding localization, nine of 16 melanomas were in the head and neck region, six were diagnosed in the gastrointestinal and urogenital tracts (three cases each), and one case had a rare localization (retroperitoneum). The most common histologic type was represented by epithelioid cells, and the majority of the tumors were achromic. Mucosal melanoma is a tumor associated with aging, all our patients being older than 53 years. Because of unspecific symptoms and low incidence, the diagnosis is often delayed and requires teamwork among the clinician, pathologist, radiologist, and oncologist. Different genetic fingerprints impose a correct diagnosis to offer the patient the best novel, personalized therapy.

Basal cell carcinomas in elderly patients treated by cryotherapy.

Basal cell carcinoma is a malignant skin tumor with high incidence in our country, especially in rural areas, on sun-exposed skin (particularly on the face) in elderly patients. We present three cases of basal cell carcinoma with good results with cryotherapy. This report aims to outline and to prove that in some difficult situations, a simple, inexpensive, easy-to-perform procedure with no contraindications and with minimal side effects (erythema, mild pain) can be applied and resolve such cases.

New Onset of Psoriasis within Plaques of Vitiligo Treated with Narrow Band UVB: Case Report

The first case of psoriasis accompanied by vitiligo was described by Selenyi in 1955 [1] and since then reports in both ways have drawn attention to this association. Although not rare, the pathogenic mechanism that can explain the coexistence of vitiligo and psoriasis remains not fully understood. Pigmentary Disorders Chiriac, et al., Pigmentary Disorders 2014, 1:2 http://dx.doi.org/10.4172/jpd.1000110

Ingrown toenails (unguis incarnatus): Nail braces/bracing treatment.

Nail bracing is a safe, simple, and inexpensive treatment option that avoids surgery, requires no anesthetic, requires no recovery period, allows wearing the existing shoes, offers immediate relief from pain, and allows the practice of daily activities. Braces can be used for prolonged periods of times. If recurrence occurs, reapplication of bracing is usually required.

Cutaneous factitia in elderly patients: alarm signal for psychiatric disorders

Background The factitious disorders, more commonly known in daily practice as pathomimia, are expressed in dermatology units by skin lesions induced voluntarily by the patient, in order to draw attention of the medical staff and/or the family members. The disorder is often challenging to diagnose and even more difficult to document in front of the patient or relatives. It represents a challenge for the physician, and any attempt at treatment may be followed by recurrence of the self-mutilation. This paper describes two cases of pathomimia diagnosed by dermatologists and treated in a psychiatry unit, highlighting the importance of collaboration in these situations. Patients and methods Two case reports, describing old female patients with pathomimia, hospitalized in a department of dermatology for bizarre skin lesions. Results The first case was a 77-year-old female with unknown psychiatric problems and atrophic skin lesions on the face, self-induced for many months, with multiple hospitalizations in dermatology units, with no response to different therapeutic patterns, and full recovery after psychiatric treatment for a major depressive syndrome. The second case was a 61-year-old female patient with disseminated atrophic scars on the face, trunk, and limbs. She raised our interest because of possible psychiatric issues, as she had attempted to commit suicide. The prescription of antidepressants led to a significant clinical improvement. Conclusion These cases indicate that a real psychiatric disease may be recorded in patients suffering from pathomimia. Therefore, complete psychiatric evaluation in order to choose the proper therapy is mandatory for all these cases. Dermatologists and all physicians who take care of old patients must recognize the disorder in order to provide optimum care for this chronic condition. We emphasize therefore the importance of psychiatric evaluation and treatment to avoid the major risk of suicide. Skin lesions must be regarded as an alarm signal in critical cases, especially in senior people.

Primary cutaneous cryptococcosis during infliximab therapy

We present the case of a HIV seronegative 72-year-old woman with a 5-year history of seronegative rheumatoid arthritis (RA), treated with infliximab (3 mg/kg in weeks 0, 2 and 6, and every 8 weeks afterwards) for 36 months, who developed a pruritic erythematous plaque on the right malar area, which evolved into an ulcerated tumor (Figure 1A). The patient had neither fever nor lymphadenopathy and denied any previous trauma, exposure to bird droppings or outdoor activities. Laboratory investigations were normal, except a high level of C reactive protein and an increased erythrocyte sedimentation rate. A diagnosis of ulcerated basal cell carcinoma was considered. 2 | METHODS

Onychodystrophy and Scarring Alopecia in Epidermolysis Bullosa Acquisita: ACase Based Review of the Literature

Introduction: Epidermolysis bullosa acquisita is a rare, autoimmune subepidermal bullous disease. Besides blisters appearance which heals with scars and milia cysts formation, nails undergo different changes: onychomadesis, onycholysis, onychorrhexis and matrix destruction. Case report: We present the case of a 59 years old patient, which showed multiple blisters, erosions, crusts located on the elbows, knees, hands, and feet; some lesions healed and formed hypo or hyperpigmented. scars in the evolution. On the scalp were observed areas of scar alopecia. In the oral cavity there were extensive erosions, painful dysphagia to both solid and liquid food, which in time contributed to significant weight loss. To the fingers and toes, the patient underwent nail loss, these being to be replaced with scar tissue. The only remaining nails are at the fourth and fifth fingers of both hands, but also those showing lesions of onycholysis and onychorrhexis leading to a thin epidermal nail. Conclusions: Our case report is the third case described in the literature. Onychomadesis manifestations and nail absence, although rare, complete the cutaneous manifestations of Epidermolysis bullosa acquisita.

Lymphomatoid Papulosis Misdiagnosed as Anaplastic Lymphoma

Lymphomatoid papulosis is a very rare skin disorder, defined as a chronic, recurrent, self-healing papulonodular or papulonecrotic skin eruption with suggestive histopathological features of a cutaneous lymphoma. We report a case of a 47-year-old male with an 8 years history of recurrent papulonodular lesions, some ulcerated, located on the face, trunk and extremities. The patient has been diagnosed primary with staphylococcal infection based on the clinical features and then, after a skin biopsy with anaplastic large cell lymphoma with CD30 positive cells and treated with CHOP. When he stopped the therapy, the lesions reappeared. A second skin biopsy was performed. Histological examination revealed an infiltrate of dyscohesive atypical lymphoid cells at the dermal-epidermal junction extending in the deep dermis. These atypical lymphoid cells varied in size and had pale abundant cytoplasm. Mitoses including atypical forms were prominent. Small mature appearing lymphocytes admixed with neutrophils and eosinophils were scattered throughout the tumor. Immunohistochemical studies demonstrated that the atypical lymphoid cells expressed CD30, Bcl-2 and Ki-67 (90%). Considering also the clinicopathological correlation, the morphological and immunohistochemical stains were suggestive for the diagnosis of lymphomatoid papulosis type A. Keywords: Lymphomatoid papulosis

A case of subacute thyroiditis in a patient on adalimumab for treatment of refractory palmo-plantar psoriasis

Recent reports indicate different side-effects of the new medication for psoriasis. Adalimumab. Adalimumab is a biologic agent acting as tumor necrosis factor alpha inhibitor. It is wildly used in treating psoriasis, following a national guide treatment. We report a clinical case of subacute thyroiditis induced by adalimumab in a psoriatic patient. A 54-year-old Caucasian female addressed to our dermatology clinic in 2008 with a 3 years history of moderate to severe psoriasis. The patient had been experiencing non-disabling joint pain in both knees and wrists for several years. Her medical history was remarkable for pulmonary sarcoidosis (at the age of 32), arterial hypertension and angina pectoris. The patient was started on adalimumab 40 mg twice monthly with good clinical evolution, but she was diagnosed, a few months after starting the therapy, with subacute thyroiditis with severe evolution, with transitory hyperthyroidism (thyroid stimulating hormone 0.1 uIU/ml). The treatment with adalimumab was discontinued, the symptoms cleared in 3 weeks with non-steroidal anti-inflammatory drugs and a fully recovered thyroid status was obtained in 1 month. The patient continued the psoriatic medication (adalimumab) with no influence on thyroid status. We describe a case of subacute thyroiditis in a psoriatic patient treated with adalimumab, with a very good clinical evolution with non-steroidal anti-inflammatory medication. Liaison between dermatologists and in this case, endocrinologists and rheumatologists, will help to determine the prevalence of these reactions and to provide insights into the very complex mechanisms of both diseases.

Pros and cons of biological therapy in psoriasis.

mumab, early TLS is not expected with this treatment. Recent study has shown that melanoma tumour cells may express CTLA-4. The authors report that ipilimumab reacts with CTLA-4 on melanoma tumour cells and triggers antibodydependant cellular cytotoxicity (ADCC). ADCC results in interaction between target cells and antibodies. ADCC is mediated by the Fc fragment of antibodies that both activate cytotoxic cells and induce cell death through perforin/granzyme and CD95/ CD95L. We suppose that ADCC may explain TLS secondary to a direct interaction between tumour cells and ipilimumab that is possible if the melanoma tumour cells of this case express CTLA-4.